SPACE

MAINTAINERS
SPACE MAINTAINERS

Space maintainers are appliances
used to maintain space or regain
minor amounts of space lost, so as
to guide the unerupted tooth into a
proper position in the arch.
IDEAL REQUIREMENTS
.It should maintain the entire mesio-distal
space
created by a lost tooth.
. It must restore the function as far as
possible &
prevent over-eruption of opposing teeth.
. It should be simple in construction.
. It should be strong enough to withstand the
functional forces.


CLASSIFICATION OF SPACE
MAINTAINERS
1)Acc. To Hitchcock-
.Removable or fixed or semi-fixed.
.With bands or without bands.
.Functional or non-functional.
.Active or passive.
.Certain combinations of the
above.
2) Acc. To Raymond C.Thurow-
Removable
Complete arch
Lingual arch
Extra-oral anchorage
Individual tooth
PLANNING FOR SPACE
MAINTENANCE
.a Time elapsed since loss-
When a primary tooth is removed & all
factors indicate the need for space
maintenance, it is best to insert an
appliance as soon as possible after the
extraction.
b) Dental age of the patient-
..Gron studied the emergence of permanent teeth
based on the amount of root development, as viewed
on radiographs ,at the time of emergence.
.she found that teeth erupt when three-fourths of the
root is developed, regardless of the childs chronologic
age
c) Amount of bone covering the
unerupted
Tooth-if there is bone covering the
crowns, it can be readily predicted
that eruption will not occur for many
months, a space-maintaining
appliance is indicated.


D)Congenital absence of the permanent
Tooth-
if permanent teeth are
congenitally absent, the dentist must
decide whether it is wise to hold the
space for many years until a fixed
replacement can be provided
or it is better to allow the space to close.

APPLIANCE THERAPY

Fixed space
maintainers-
Band & loop space
maintainer.
Lingual arch.
Palatal arch appliance.
Transpalatal arch.
Distal shoe space
maintainer.
Band & Bar type
space maintainer.
Removable space
maintainers-
Acrylic partial
dentures.
Full or complete
dentures.
Removable distal shoe
space maintainer.

Four appliances generally used to
maintain space in the primary
dentition are-

. The Band & Loop
.The Lingual Arch
.The Distal Shoe
.The Removable Appliance
Fixed Space
Maintainers
Space maintainers which are fixed or fitted onto the
teeth are called fixed space maintainers.

ADVANTAGES:
1. Bands and crowns are used which require minimum
or no tooth preparation.
2. They do not interfere with passive eruption of
abutment teeth.
3. Jaw growth is not hampered.
Disadvantages
1. Elaborate instrumentation with expert
skill is needed.
2. They may result in decalcification of
tooth material under the bands.
3. Supra eruption of opposing teeth can
take place if pontics are not used.
CONSTRUCTION OF SPACE
MAINTAINER
BAND
LOOP/ARCH WIRE
SOLDER JOINT
AUXILLARIES

BAND-
The band forms an important part of
the constructions of the various fixed
appliances several bands are
employed such as-
1) Loop bands
2) Tailored bands
3) Preformed seamless band
made of precious metal or chrome
alloy.

Every band should possess a
few ideal criteria such that-

.Should not extend subgingivally any more
than necessary.
.Band material should resist deformation
.under stresses in the mouth.
.Resist tarnish.
.Inherent springiness.
.Cause no occlusal interference
STEPS IN BAND FORMATION
SEPARATION
BAND FITING (band pinching)
WELDING
SOLDERING
SEPARATION
Adequate separation of teeth is an essential
prerequisite for any banding technique.
METHODS
Brass wire-0.015-0.020 inch soft brass wire.
Elastic threads-these provide a gentle force over a
prolonged period.
WELDING-
It is the process during which a
portion of the metal being joined is
melted & flowed together.

Bands are generally joined by
welding.
SOLDERING-
It is the process by which the
two metals are joined together by
an intermediary metal of a lower
fusion temperature.
BAND PINCHING
Band strips are first contoured in an incisogingival
direction using johnson contouring pliers
Bands should be pinched on cuspal area .
The upper molar band is usually pulled from palatal side.
The upper band will be kept at mesiolingual line angle
whereas for lower at mesiolingual line angle.
Two edges of seam should be parallel to each other so
that band rests uniformly on tooth surface.


COMMONLY USED SPACE
MAINTAINERS IN PRIMARY
DENTITION ARE:
BAND AND LOOP
NANCE PALATAL HOLDING DEVICE
TRANSPALATAL ARCH
DISTAL SHOE
REMOVABLE SPACE MAINTAINERS
.LINGUAL ARCH HOLDING DEVICE
BAND AND LOOP
APPLIANCE(FIXED,NON
FUNCTIONAL,PASSIVE SPACE
MAINTAINER)
INDICATIONS
. Unilateral loss of the primary first
molar before or after eruption of the
permanent first molar.
.Bilateral loss of a primary molar
before the eruption of the permanent
incisors.
CONSTRUCTION OF BAND AND
LOOP SPACE MAINTAINER
second deciduous molar, is used for
anchorage of appliance. loop is soldered
to band.
The loop is contoured to rest on the tissue
on both sides of ridge with an opening in
the loop sufficient to permit the eruption of
cusps of underlying permanent tooth .
the loop should contact the mesial
abutment at contact point.

LINGUAL ARCH (FIXED NON
FUNCTIONAL,PASSIVEMANDIBULAR
ARCH APPLIANCE
INDICATIONS
IT IS INDICATED TO PRESERVE THE
SPACE CREATED BY MULTIPLE LOSS
OF PRIMARY MOLARS.
IT HELPS IN MAINTAINING ARCH
PERIMETER BY PREVENTING BOTH
MESIAL DRIFTING OF MOLARS.


CONSTRUCTION
It consist of two cemented on first
permanent molars or two deciduous
molars.
They joined by stainless steel
contacting lingual surface of four
mandibular incisors.

PASSIVATION-
The lingual archwire should be
completely passive.This is done by
heating the wire to a dull brownish
appearance, while keeping the wire
gently in place on the cingula with
an old instrument.
NANCE ARCH OR Fixed,Non-
functional,Passive,Maxillary arch
appliance)
.Nance(1947) described the
preventive lingual wire.
.It consists of bands on the upper
molars, with the arch wire extending
forward into the vault.
CONSTRUCTION-
The acrylic button is present on the
slope of the palate & provides an
excellent resistance against forward
movement(U loop). The wire should extend
from the lingual of bands to the deepest
& most anterior point in the middle of
hard palate.

U bend is given in the wire for the
retention of the acrylic 1-2mm away
from the soft tissue
TRANSPALATAL ARCH (Fixed,Non-
functional,Passive
appliance)
.
INDICATION
Tran palatal arch has been
recommended for stablising
maxillary first permanent molars
when primary molars require
extraction.
CONSTRUCTION
The transpalatal arch consists of thick
stainless steel wire that spans the palatal
connecting the first permanent molar of
one side with the other.
DISTAL SHOE APPLIANCE
Indication:
Loss of a primary
second molar before the
eruption of the first
permanent molar.
Contraindications:
Poor oral hygiene
Medically compromised pt
Criteria for appliance fabrication:
0.9MM STAINLESS STEEL WIRE IS
USED.
THE FLAT SURFACE OF THE BAR
IS BENT TO REQUIRED SHAPE.
IT IS ENSURED THAT VERTICAL
RELATIONSHIP OF THE
HORIZONTAL BAR OF THE DISTAL
SHOE DOES NOT CONTACT THE
OPPOSING TOOTH.
DISTAL SHOE IS THEN SOLDERED
TO METAL CROWN AND POLISH.ED
REMOVABLE SPACE
MAINTAINERS
REMOVABLE SPACE MAINTAINERS ARE THE
SPACE MAINTAINERS WHICH CAN BE REMOVED
EASILY.
Indication:
1.When aesthetics is of importance.
2.In case the abutment teeth cannot support
a fixed appliance.
3.In cleft palate patients who require
obturation of the palatal defect.
4.In case the radiograph reveals that the
unerupted permanent tooth is not going to
erupt in less than five months time.
CONTRAINDICATIONS-
1.Lack of patient cooperation.
2.patients who are allergic to
acrylic material.
3.Epileptic patients.
Advantages:
1. Easy to clean and permit maintenance of
proper oral hygiene.
2. Maintain or restore the vertical dimension.
3. Can be worn part time allowing circulation
of the blood to the soft tissues.
4. Room can be made for permanent teeth to
erupt without changing the appliance.

DISADVANTAGES:
1. May be lost or broken by the patient.
2. Un-co-operative patients may not
wear the appliance.
3. Lateral jaw growth may be restricted,
if clasps are incorporated.
4. May cause irritation of the underlying
soft tissues